We must protect NHS democracy

As the Green Party Spring Conference kicks off in Liverpool today, Caroline Lucas MP writes exclusively for OurNHS about the threats to NHS democracy in England.

Image: Green Party

The Coalition told us it
wanted to hand control of the NHS to patients - but instead is attacking NHS
democracy on every side.

Before Christmas, I spent
an evening as an observer with an ambulance team in Brighton. The shift continued well past its official
finish time of 1am. I left with an even stronger sense of the commitment and
dedication of our hard-working, professional NHS staff.

The
health service remains the country’s most cherished institution, polls tell us.
It is uniquely bound up in our sense of
who we are. The memory of Danny Boyle’s wonderful and creative depiction of the
NHS at the Olympics is still so vivid because it embodies that sense. Forged in
post-war Britain as part of our collective will to build a better, fairer
society, we feel that it belongs to us more passionately than we do any other
public service.

The outcry at the Health
and Social Care Act wasn’t just about the commercialisation of the NHS. It was
about an affront to our democratic values. The Conservatives had promised there
would be “no more top-down reorganisation of the NHS”. But on gaining office
they quickly announced the biggest restructuring of the NHS in its history, a reorganisation so large its head said it was "visible from space".

The new structures are Kafkaesque
(I have complicated organisational flow charts on the walls of my office to try
and help me understand who is accountable for what).

Another dent in democracy
is that private companies providing NHS care can be far more secretive about their
activities. They can circumvent Freedom of Information requests on the basis of
commercial confidentiality.

The commercialisation of
health services that the Act has accelerated adds to the democratic deficit.

Has the Coalition learned
its lesson from the wave of public and professional protest against the Health
and Social Care Act?

Far from it.

They’re now trying to push
through another piece of legislation taking away much of the power of local
communities to have a say in what happens to their local hospitals and NHS services.

The Care Bill - reaching
its final votes in a couple of weeks - is by no means all bad. In fact it’s an
important Bill that aims to bring up to date the legal framework underpinning
the care system. But it also contains the frankly outrageous Clause 118. This
clause would give government agents powers to recommend and impose changes not
just to “financially failing” trusts they are brought in to sort out, but also
to neighbouring trusts, potentially denying the public and patients in those
areas any real say.

The
move follows last year’s embarrassing defeat in the Appeal Court, which ruled
that the Health Secretary did not have powers to implement cuts to Lewisham
Hospital’s Accident and Emergency and maternity services.

The Government is trying
to sneak through a fundamental shift in the way future decisions about local
services are made.

If they thought we
wouldn’t notice that backhand attempt to change the rules they were wrong. There
is both strong cross party opposition and grass roots opposition to the clause.
Democracy hasn’t been smothered yet.

As if
this weren't enough, the attack on the democracy of our most loved national
institution could be ramped up by the Transatlantic Trade and Investment
Partnership (TTIP). If it goes ahead, it could see the multinational health
giants that are circling around and snapping up billions of pounds worth of NHS
contracts file complaints directly to international tribunals, completely
bypassing national courts should they perceive threats to their interests from our
elected Government.

Two
other pieces of government legislation complete a five pronged attack on the
democracy of the NHS. The Chair of the British Medical Association raised
concerns that the Gagging Bill – now sadly law despite public outcry - could
prevent people from speaking out against the threat of privatisation, remarking
that the Coalition "doesn’t like to hear anyone but themselves talking”. The
requirement to divide spending on constituency lines will mean large
administrative burdens for many health campaigns, for example against hospital
closures that affect more than one area.

Like
the Gagging Bill, the Deregulation Bill currently before parliament is
wide-ranging in scope. It’s when we look at what it might mean for the NHS that
we see why so much in it is absurd. The Bill imposes a new duty on non-economic
regulators to promote economic growth. What exactly would that mean for the
Care Quality Commission? How exactly would the Medicines and Healthcare
Regulatory Agency, which regulates the pharmaceutical industry, promote growth?

Successive
governments have talked about the need to empower patients, to make the NHS
more accountable and to improve choice. Yet in reality, their policies have
often disenfranchised communities, perhaps because their understanding of what
choice and freedom mean is inextricably bound up with ideas of markets, and
profits, rather than genuine people power.

Nye
Bevan famously said that the NHS will last as long as there are folk left with
the faith to fight for it. We have a
service we want to protect passionately. The democratic tools we need to do so
are threatened.

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About the author

Caroline Lucas is the Green MP for Brighton Pavilion, and and since September 2016, Co-Leader of the Green Party of England and Wales, a position shared with Jonathan Bartley.

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